Healthcare Provider Details

I. General information

NPI: 1629373923
Provider Name (Legal Business Name): DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SOUTH VERMONT AVE. 10TH FLOOR
LOS ANGELES CA
90020
US

IV. Provider business mailing address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-4431
  • Fax: 213-351-2490
Mailing address:
  • Phone: 213-738-4431
  • Fax: 213-351-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number29410
License Number StateCA

VIII. Authorized Official

Name: MS. LINDA P. BOYD
Title or Position: PROGRAM HEAD
Credential: MN
Phone: 213-738-4431